To Learn the Lessons, the COVID-19 Public Inquiry Must Consider the Experiences of Migrants During the Pandemic 

Matteo Besana is the COVID-19 Advocacy Project Lead for Doctors of the World UK

Matteo Besana

Earlier in the year, the government published the draft Terms of Reference for the forthcoming public inquiry into the COVID-19 pandemic which will examine the UK Government’s response to the pandemic with the hope of learning the lessons from the pandemic and informing the government’s preparations for the future.

Here at Doctors of the World we believe that key to this exercise, and to the work of the Inquiry, is to consider the experiences and the barriers that many migrants, refugees and asylum seekers have in accessing health services and other public services during the pandemic. The inquiry also needs to consider the intersection between health services, and barriers to those services for migrants as a result of the ‘hostile environment’ government policy.

This opinion is informed and shaped by our work help, supporting and advocating for people who are excluded on a daily basis from the healthcare system. In fact, many people living in the UK found it impossible to access mainstream health services before the pandemic– despite being fully entitled to them – due to fear, not knowing the system, having to pay charges or being wrongly turned away by frontline healthcare staff. These barriers were exacerbated when the COVID-19 virus arrived in the UK.

In May 2020 we published the findings of a rapid needs assessment which found that socially excluded populations, including undocumented migrants and refused asylum seekers, people experiencing homelessness, Gypsy, Roma and Traveller communities and sex workers, were:

  • at increased risk of being exposed to COVID-19
  • more likely to have poorly managed pre-existing chronic health problems;
  • less likely to access timely healthcare if they become unwell with COVID-19;
  • less able to self-isolate and protect themselves and others from further transmission.

And yet, despite these findings, we know that these populations were often some of the most excluded from essential services during the pandemic despite their increased need for protection and support.

Our work before and during the pandemic has been to identify gaps and barriers in the healthcare system that were preventing socially excluded populations from accessing a variety of services to which they were entitled. This includes for instance registering with a GP, receiving the COVID-19 vaccine, or accessing their COVID pass.

What are the key issues and learning we hope the Inquiry will consider as part of its work to highlight learnings in order to better prepare government for future pandemics?

For brevity, I will highlight 3 key issues which I think are vital to consider:

Improving access to primary care including GP registration and NHS number

As evidence from our work and from recent media pieces highlight, barriers to GP registration are still the biggest issues preventing people from receiving the medical care they are entitled to, including the COVID-19 vaccine.

The first issue the Inquiry and policy makers should consider and act upon is the need to improve the accessibility and easiness of registration for everyone, regardless of immigration status and personal circumstances. This would reflect the current rules and policies that clearly states how everybody is entitled to register with a GP.

GP registration is also the key element through which prospective patients receive an NHS number. A number which is the gateway to access a series of free NHS services. Throughout the pandemic having an NHS number also allowed people to access COVID-19 services including the vaccine through the mainstream route (i.e. not having to rely on outreach / ad hoc methods) to receive those services.

Key to expand and improve GP registration across the country is a clear endorsement and promotion of Doctors of the World’s Safe Surgeries Initiative. A Safe Surgery can be any GP practice which commits to taking steps to tackle the barriers faced by many migrants in accessing healthcare. At a minimum, this means declaring your practice a ‘Safe Surgery’ for everyone and ensuring that lack of ID or proof of address, immigration status or language are not barriers to patient registration.

Timely access to translated health information

Since the beginning of the pandemic, our organisation has produced and disseminate a variety of translated health information including COVID-19 public health materials, in up to 60 languages, that have been viewed and downloaded by organisations and individuals supporting migrants more than 90 thousand times from a purposedly built translated health information hub.

Another key issue we hope the Inquiry will consider and learn from is for the need to information, particularly health information to be readily available in all the languages spoken in communities across the UK. This would help everyone in our communities, easily understand for instance how to self-isolate, the importance of regular testing and so on, as well as countering the disinformation on vaccines that was sadly widespread across the public at the height of the vaccination campaign.

Key to this, is to also make public websites, including those of GP surgeries, as easily understandable as possible as well as always think about alternative methods for people who don’t have access or the financial means to access online services.

Fear of the Hostile Environment

The final, and perhaps the most important issue the Inquiry should consider, are the negative implications and the divisions the Hostile Environment has caused and is causing in our communities, with people remaining fearful or scared of accessing vital healthcare even during a pandemic.

As we mark the 10 years since the introduction of those policies that came to be known as the Hostile Environment, we are on a daily basis seeing the impact of having transformed everyone in our society in “informal border guards”.

In healthcare, the Hostile Environment has caused people to hide from the healthcare system, even at a time when for public health reasons, authorities were rightly trying to reach and vaccinate everyone in our communities.

This proves that calls from organisations including ourselves at the beginning of the pandemic for the establishment of a “firewall” – i.e. a clear separation between health authorities and the rest of government – were and remain correct. If we have spent more than a decade purposedly excluding people from public services, including essential ones like healthcare, we cannot expect people to trust the same authorities that have done everything to make Britain the hostile country it is today.

These are some of the key pillars we hope the Inquiry will consider when assessing the experiences of migrants living in the UK during the pandemic in order to be better prepared for future ones. We owe it to the many key workers, many of whom are from a migrant background and saw the exclusion that their friend, families and communities were suffering due to hostile policies in the public sector including healthcare.

Immigration enforcement make for poor public health and put migrants and the communities at large at risk. We hope the Inquiry will also come to the same conclusion and recognise the importance of prioritising health and the wellbeing of everyone in our communities over immigration enforcement.